To the Editor.—Although Dr Small and
colleagues1 emphasize pharmacological intervention
for Alzheimer disease from which only partial efficacy can be expected, little
attention has been paid to the role of some nonpharmacological interventions
for which efficacy, albeit moderate, has been demonstrated.2,3
Small et al, strictly mimicking the conclusions recently published by the
American Psychiatric Association,4 state,
"As the cognitive improvements associated with reality orientation and memory
retraining are weak, many specialists believe the potential risks outweigh
the benefits."1(p1366) In drawing this conclusion,
however, the authors do not take into account recent findings on procedural
memory (cognitive, sensory, and motor) stimulation and cognition-oriented
treatments in Alzheimer disease; moreover, they seem to overstate adverse
events while understating potential benefits of cognition-oriented psychotherapies.